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Zohoury N, Bertolaccini ML, Rodriguez-Garcia JL, Shums Z, Ateka-Barrutia O, Sorice M, Norman GL, Khamashta M. Closing the Serological Gap in the Antiphospholipid Syndrome: The Value of "Non-criteria" Antiphospholipid Antibodies. J Rheumatol 2017; 44:1597-1602. [PMID: 28864642 DOI: 10.3899/jrheum.170044] [Citation(s) in RCA: 68] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/14/2017] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Most clinicians use the 2006 Sydney classification criteria to evaluate patients suspected of having antiphospholipid syndrome (APS). Although sensitive and specific for APS, many patients fulfilling clinical criteria for the syndrome are persistently negative for the specific serological tests ("laboratory criteria"). These "seronegative APS" (SN-APS) patients can go undiagnosed and untreated until they experience serious clinical events. This study's objective was to describe antibody profiles of SN-APS patients using non-criteria markers, assess the clinical utility of these markers separately and in combination, and suggest incorporation into guidelines for patients suspected of APS. METHODS We categorized 175 consecutive patients suspected of APS into 2 subgroups: 107 fulfilling Sydney APS classification for seropositive APS (SP-APS) and 68 with clinical manifestations suggestive of APS but having negative serology, on 2 occasions, for criteria markers (SN-APS). On study inclusion, samples were retested for criteria and 11 non-criteria markers, including antiphosphatidylserine/prothrombin antibodies. RESULTS Using 4 of 11 non-criteria tests, a cumulative 30.9% of SN-APS patients were detected. Combining results of all 11 non-criteria tests, 25 SN-APS (36.8%) and 89 SP-APS (83.2%) were positive for 1 or more non-criteria antibodies. CONCLUSION Failure to diagnose APS can result in severe clinical consequences. Patients displaying clinical features of APS, but negative for conventional criteria markers, should undergo additional testing for non-criteria biomarkers. In our cohort, around one-third of SN-APS patients showed reactivity to 1 or more non-criteria markers. An update to the current classification criteria incorporating new serological markers should be considered to identify and stratify patients with APS for more effective treatment and management.
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Affiliation(s)
- Navid Zohoury
- From Inova Diagnostics Inc., San Diego, California, USA; Academic Department of Vascular Surgery, King's College London; Graham Hughes Lupus Research Laboratory, Lupus Research Unit, The Rayne Institute, Division of Women's Health, King's College London, St. Thomas' Hospital, London, UK; Department of Internal Medicine, University of Castilla-La Mancha, Albacete, Spain; Department of Experimental Medicine, La Sapienza University, Rome, Italy. .,Navid Zohoury, Zakera Shums, and Gary L. Norman are employees of Inova Diagnostics. .,N. Zohoury, BS, Inova Diagnostics Inc.; M.L. Bertolaccini, PhD, Academic Department of Vascular Surgery, King's College London; J.L. Rodriguez-Garcia, PhD, Department of Internal Medicine, University of Castilla-La Mancha; Z. Shums, MSc, Inova Diagnostics Inc.; O. Ateka-Barrutia, MD, Graham Hughes Lupus Research Laboratory, Lupus Research Unit, The Rayne Institute, Division of Women's Health, King's College London, St. Thomas' Hospital; M. Sorice, MD, Department of Experimental Medicine, La Sapienza University; G.L. Norman, PhD (AGAF, FAASLD), Inova Diagnostics Inc.; M. Khamashta, MD, PhD (FRCP), Graham Hughes Lupus Research Laboratory, Lupus Research Unit, The Rayne Institute, Division of Women's Health, King's College London, St. Thomas' Hospital.
| | - Maria Laura Bertolaccini
- From Inova Diagnostics Inc., San Diego, California, USA; Academic Department of Vascular Surgery, King's College London; Graham Hughes Lupus Research Laboratory, Lupus Research Unit, The Rayne Institute, Division of Women's Health, King's College London, St. Thomas' Hospital, London, UK; Department of Internal Medicine, University of Castilla-La Mancha, Albacete, Spain; Department of Experimental Medicine, La Sapienza University, Rome, Italy.,Navid Zohoury, Zakera Shums, and Gary L. Norman are employees of Inova Diagnostics.,N. Zohoury, BS, Inova Diagnostics Inc.; M.L. Bertolaccini, PhD, Academic Department of Vascular Surgery, King's College London; J.L. Rodriguez-Garcia, PhD, Department of Internal Medicine, University of Castilla-La Mancha; Z. Shums, MSc, Inova Diagnostics Inc.; O. Ateka-Barrutia, MD, Graham Hughes Lupus Research Laboratory, Lupus Research Unit, The Rayne Institute, Division of Women's Health, King's College London, St. Thomas' Hospital; M. Sorice, MD, Department of Experimental Medicine, La Sapienza University; G.L. Norman, PhD (AGAF, FAASLD), Inova Diagnostics Inc.; M. Khamashta, MD, PhD (FRCP), Graham Hughes Lupus Research Laboratory, Lupus Research Unit, The Rayne Institute, Division of Women's Health, King's College London, St. Thomas' Hospital
| | - Jose Luis Rodriguez-Garcia
- From Inova Diagnostics Inc., San Diego, California, USA; Academic Department of Vascular Surgery, King's College London; Graham Hughes Lupus Research Laboratory, Lupus Research Unit, The Rayne Institute, Division of Women's Health, King's College London, St. Thomas' Hospital, London, UK; Department of Internal Medicine, University of Castilla-La Mancha, Albacete, Spain; Department of Experimental Medicine, La Sapienza University, Rome, Italy.,Navid Zohoury, Zakera Shums, and Gary L. Norman are employees of Inova Diagnostics.,N. Zohoury, BS, Inova Diagnostics Inc.; M.L. Bertolaccini, PhD, Academic Department of Vascular Surgery, King's College London; J.L. Rodriguez-Garcia, PhD, Department of Internal Medicine, University of Castilla-La Mancha; Z. Shums, MSc, Inova Diagnostics Inc.; O. Ateka-Barrutia, MD, Graham Hughes Lupus Research Laboratory, Lupus Research Unit, The Rayne Institute, Division of Women's Health, King's College London, St. Thomas' Hospital; M. Sorice, MD, Department of Experimental Medicine, La Sapienza University; G.L. Norman, PhD (AGAF, FAASLD), Inova Diagnostics Inc.; M. Khamashta, MD, PhD (FRCP), Graham Hughes Lupus Research Laboratory, Lupus Research Unit, The Rayne Institute, Division of Women's Health, King's College London, St. Thomas' Hospital
| | - Zakera Shums
- From Inova Diagnostics Inc., San Diego, California, USA; Academic Department of Vascular Surgery, King's College London; Graham Hughes Lupus Research Laboratory, Lupus Research Unit, The Rayne Institute, Division of Women's Health, King's College London, St. Thomas' Hospital, London, UK; Department of Internal Medicine, University of Castilla-La Mancha, Albacete, Spain; Department of Experimental Medicine, La Sapienza University, Rome, Italy.,Navid Zohoury, Zakera Shums, and Gary L. Norman are employees of Inova Diagnostics.,N. Zohoury, BS, Inova Diagnostics Inc.; M.L. Bertolaccini, PhD, Academic Department of Vascular Surgery, King's College London; J.L. Rodriguez-Garcia, PhD, Department of Internal Medicine, University of Castilla-La Mancha; Z. Shums, MSc, Inova Diagnostics Inc.; O. Ateka-Barrutia, MD, Graham Hughes Lupus Research Laboratory, Lupus Research Unit, The Rayne Institute, Division of Women's Health, King's College London, St. Thomas' Hospital; M. Sorice, MD, Department of Experimental Medicine, La Sapienza University; G.L. Norman, PhD (AGAF, FAASLD), Inova Diagnostics Inc.; M. Khamashta, MD, PhD (FRCP), Graham Hughes Lupus Research Laboratory, Lupus Research Unit, The Rayne Institute, Division of Women's Health, King's College London, St. Thomas' Hospital
| | - Oier Ateka-Barrutia
- From Inova Diagnostics Inc., San Diego, California, USA; Academic Department of Vascular Surgery, King's College London; Graham Hughes Lupus Research Laboratory, Lupus Research Unit, The Rayne Institute, Division of Women's Health, King's College London, St. Thomas' Hospital, London, UK; Department of Internal Medicine, University of Castilla-La Mancha, Albacete, Spain; Department of Experimental Medicine, La Sapienza University, Rome, Italy.,Navid Zohoury, Zakera Shums, and Gary L. Norman are employees of Inova Diagnostics.,N. Zohoury, BS, Inova Diagnostics Inc.; M.L. Bertolaccini, PhD, Academic Department of Vascular Surgery, King's College London; J.L. Rodriguez-Garcia, PhD, Department of Internal Medicine, University of Castilla-La Mancha; Z. Shums, MSc, Inova Diagnostics Inc.; O. Ateka-Barrutia, MD, Graham Hughes Lupus Research Laboratory, Lupus Research Unit, The Rayne Institute, Division of Women's Health, King's College London, St. Thomas' Hospital; M. Sorice, MD, Department of Experimental Medicine, La Sapienza University; G.L. Norman, PhD (AGAF, FAASLD), Inova Diagnostics Inc.; M. Khamashta, MD, PhD (FRCP), Graham Hughes Lupus Research Laboratory, Lupus Research Unit, The Rayne Institute, Division of Women's Health, King's College London, St. Thomas' Hospital
| | - Maurizio Sorice
- From Inova Diagnostics Inc., San Diego, California, USA; Academic Department of Vascular Surgery, King's College London; Graham Hughes Lupus Research Laboratory, Lupus Research Unit, The Rayne Institute, Division of Women's Health, King's College London, St. Thomas' Hospital, London, UK; Department of Internal Medicine, University of Castilla-La Mancha, Albacete, Spain; Department of Experimental Medicine, La Sapienza University, Rome, Italy.,Navid Zohoury, Zakera Shums, and Gary L. Norman are employees of Inova Diagnostics.,N. Zohoury, BS, Inova Diagnostics Inc.; M.L. Bertolaccini, PhD, Academic Department of Vascular Surgery, King's College London; J.L. Rodriguez-Garcia, PhD, Department of Internal Medicine, University of Castilla-La Mancha; Z. Shums, MSc, Inova Diagnostics Inc.; O. Ateka-Barrutia, MD, Graham Hughes Lupus Research Laboratory, Lupus Research Unit, The Rayne Institute, Division of Women's Health, King's College London, St. Thomas' Hospital; M. Sorice, MD, Department of Experimental Medicine, La Sapienza University; G.L. Norman, PhD (AGAF, FAASLD), Inova Diagnostics Inc.; M. Khamashta, MD, PhD (FRCP), Graham Hughes Lupus Research Laboratory, Lupus Research Unit, The Rayne Institute, Division of Women's Health, King's College London, St. Thomas' Hospital
| | - Gary L Norman
- From Inova Diagnostics Inc., San Diego, California, USA; Academic Department of Vascular Surgery, King's College London; Graham Hughes Lupus Research Laboratory, Lupus Research Unit, The Rayne Institute, Division of Women's Health, King's College London, St. Thomas' Hospital, London, UK; Department of Internal Medicine, University of Castilla-La Mancha, Albacete, Spain; Department of Experimental Medicine, La Sapienza University, Rome, Italy.,Navid Zohoury, Zakera Shums, and Gary L. Norman are employees of Inova Diagnostics.,N. Zohoury, BS, Inova Diagnostics Inc.; M.L. Bertolaccini, PhD, Academic Department of Vascular Surgery, King's College London; J.L. Rodriguez-Garcia, PhD, Department of Internal Medicine, University of Castilla-La Mancha; Z. Shums, MSc, Inova Diagnostics Inc.; O. Ateka-Barrutia, MD, Graham Hughes Lupus Research Laboratory, Lupus Research Unit, The Rayne Institute, Division of Women's Health, King's College London, St. Thomas' Hospital; M. Sorice, MD, Department of Experimental Medicine, La Sapienza University; G.L. Norman, PhD (AGAF, FAASLD), Inova Diagnostics Inc.; M. Khamashta, MD, PhD (FRCP), Graham Hughes Lupus Research Laboratory, Lupus Research Unit, The Rayne Institute, Division of Women's Health, King's College London, St. Thomas' Hospital
| | - Munther Khamashta
- From Inova Diagnostics Inc., San Diego, California, USA; Academic Department of Vascular Surgery, King's College London; Graham Hughes Lupus Research Laboratory, Lupus Research Unit, The Rayne Institute, Division of Women's Health, King's College London, St. Thomas' Hospital, London, UK; Department of Internal Medicine, University of Castilla-La Mancha, Albacete, Spain; Department of Experimental Medicine, La Sapienza University, Rome, Italy.,Navid Zohoury, Zakera Shums, and Gary L. Norman are employees of Inova Diagnostics.,N. Zohoury, BS, Inova Diagnostics Inc.; M.L. Bertolaccini, PhD, Academic Department of Vascular Surgery, King's College London; J.L. Rodriguez-Garcia, PhD, Department of Internal Medicine, University of Castilla-La Mancha; Z. Shums, MSc, Inova Diagnostics Inc.; O. Ateka-Barrutia, MD, Graham Hughes Lupus Research Laboratory, Lupus Research Unit, The Rayne Institute, Division of Women's Health, King's College London, St. Thomas' Hospital; M. Sorice, MD, Department of Experimental Medicine, La Sapienza University; G.L. Norman, PhD (AGAF, FAASLD), Inova Diagnostics Inc.; M. Khamashta, MD, PhD (FRCP), Graham Hughes Lupus Research Laboratory, Lupus Research Unit, The Rayne Institute, Division of Women's Health, King's College London, St. Thomas' Hospital
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Foltyn Zadura A, Memon AA, Stojanovich L, Perricone C, Conti F, Valesini G, Bogdanovic G, Hillarp A, Shoenfeld Y, Sundquist J, Leffler J, Svensson PJ, Trouw LA, Blom AM. Factor H Autoantibodies in Patients with Antiphospholipid Syndrome and Thrombosis. J Rheumatol 2015; 42:1786-93. [PMID: 26276971 DOI: 10.3899/jrheum.150185] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/30/2015] [Indexed: 01/17/2023]
Abstract
OBJECTIVE Autoantibodies to complement factor H (FH) are associated with atypical hemolytic uremic syndrome, but can also be detected in patients with rheumatoid arthritis and in patients positive for lupus anticoagulants and thus potentially antiphospholipid syndrome (APS). To our knowledge, no data are available on the association between the presence of FH autoantibodies in APS and clinical manifestations. METHODS We determined FH autoantibody levels using ELISA in 2 cohorts of patients with primary (PAPS) and secondary APS (SAPS) from Serbia and Italy, and an additional cohort including patients with venous thromboembolism (VTE) from Sweden. RESULTS FH autoantibodies were detected in 13.7% of patients (n = 73) with PAPS and 30.3% of patients (n = 33) with SAPS in the Serbian cohort. FH autoantibody frequency in the Italian cohort was 33.3% (n = 15) and 36% (n = 25) in PAPS and SAPS, respectively. Both FH autoantibody levels and frequencies observed in both APS cohorts were significantly higher than in matched healthy controls (5%). Further, patients with PAPS with venous thrombosis in the Serbian cohort had significantly higher levels of FH autoantibodies. Therefore, we analyzed a dedicated Swedish thrombosis cohort and found that patients with FH autoantibody positivity had higher risk of VTE recurrence (HR 2.0, 95% CI 1.2-3.3, p = 0.011) compared with the reference group of FH autoantibody-negative patients. CONCLUSION Overall, the data indicate that in patients with APS and recurrent venous thrombosis, there are increased levels of FH autoantibodies, a finding associated with poor clinical outcome.
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Affiliation(s)
- Anna Foltyn Zadura
- From the Department of Translational Medicine, and Department of Clinical Sciences, Lund University; Center for Primary Health Care Research, Skåne University Hospital, Malmö; Department of Clinical Chemistry and Transfusion Medicine, Halland Hospital, Halmstad, Sweden; Internal Medicine, "Bezhanijska Kosa," University Medical Center, Belgrade, Serbia; Dipartimento di Medicina Interna e Specialità Mediche, Sapienza Università di Roma, Rome, Italy; Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel Aviv, Israel; Telethon Kids Institute, University of Western Australia, Perth, Australia; Department of Rheumatology, Leiden University Medical Center, Leiden, the Netherlands.A. Foltyn Zadura, MSc, Department of Translational Medicine, Lund University; A.A. Memon, PhD, Center for Primary Health Care Research, Skåne University Hospital; L. Stojanovich, MD, PhD, Internal Medicine, "Bezhanijska Kosa," University Medical Center; C. Perricone, MD; F. Conti, MD, PhD; G. Valesini, MD, Dipartimento di Medicina Interna e Specialità Mediche, Sapienza Università di Roma; G. Bogdanovic, MD, PHD, Internal Medicine, "Bezhanijska Kosa," University Medical Center; A. Hillarp, PhD, Department of Clinical Chemistry and Transfusion Medicine, Halland Hospital; Y. Shoenfeld, MD, PhD, Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center; J. Sundquist, MD, PhD, Center for Primary Health Care Research, Skåne University Hospital; J. Leffler, PhD, Telethon Kids Institute, University of Western Australia; P.J. Svensson, MD, PhD, Department of Translational Medicine, Lund University; L.A. Trouw, PhD, Department of Rheumatology, Leiden University Medical Center; A.M. Blom, PhD, Department of Translational Medicine, Lund University
| | - Ashfaque A Memon
- From the Department of Translational Medicine, and Department of Clinical Sciences, Lund University; Center for Primary Health Care Research, Skåne University Hospital, Malmö; Department of Clinical Chemistry and Transfusion Medicine, Halland Hospital, Halmstad, Sweden; Internal Medicine, "Bezhanijska Kosa," University Medical Center, Belgrade, Serbia; Dipartimento di Medicina Interna e Specialità Mediche, Sapienza Università di Roma, Rome, Italy; Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel Aviv, Israel; Telethon Kids Institute, University of Western Australia, Perth, Australia; Department of Rheumatology, Leiden University Medical Center, Leiden, the Netherlands.A. Foltyn Zadura, MSc, Department of Translational Medicine, Lund University; A.A. Memon, PhD, Center for Primary Health Care Research, Skåne University Hospital; L. Stojanovich, MD, PhD, Internal Medicine, "Bezhanijska Kosa," University Medical Center; C. Perricone, MD; F. Conti, MD, PhD; G. Valesini, MD, Dipartimento di Medicina Interna e Specialità Mediche, Sapienza Università di Roma; G. Bogdanovic, MD, PHD, Internal Medicine, "Bezhanijska Kosa," University Medical Center; A. Hillarp, PhD, Department of Clinical Chemistry and Transfusion Medicine, Halland Hospital; Y. Shoenfeld, MD, PhD, Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center; J. Sundquist, MD, PhD, Center for Primary Health Care Research, Skåne University Hospital; J. Leffler, PhD, Telethon Kids Institute, University of Western Australia; P.J. Svensson, MD, PhD, Department of Translational Medicine, Lund University; L.A. Trouw, PhD, Department of Rheumatology, Leiden University Medical Center; A.M. Blom, PhD, Department of Translational Medicine, Lund University
| | - Ljudmila Stojanovich
- From the Department of Translational Medicine, and Department of Clinical Sciences, Lund University; Center for Primary Health Care Research, Skåne University Hospital, Malmö; Department of Clinical Chemistry and Transfusion Medicine, Halland Hospital, Halmstad, Sweden; Internal Medicine, "Bezhanijska Kosa," University Medical Center, Belgrade, Serbia; Dipartimento di Medicina Interna e Specialità Mediche, Sapienza Università di Roma, Rome, Italy; Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel Aviv, Israel; Telethon Kids Institute, University of Western Australia, Perth, Australia; Department of Rheumatology, Leiden University Medical Center, Leiden, the Netherlands.A. Foltyn Zadura, MSc, Department of Translational Medicine, Lund University; A.A. Memon, PhD, Center for Primary Health Care Research, Skåne University Hospital; L. Stojanovich, MD, PhD, Internal Medicine, "Bezhanijska Kosa," University Medical Center; C. Perricone, MD; F. Conti, MD, PhD; G. Valesini, MD, Dipartimento di Medicina Interna e Specialità Mediche, Sapienza Università di Roma; G. Bogdanovic, MD, PHD, Internal Medicine, "Bezhanijska Kosa," University Medical Center; A. Hillarp, PhD, Department of Clinical Chemistry and Transfusion Medicine, Halland Hospital; Y. Shoenfeld, MD, PhD, Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center; J. Sundquist, MD, PhD, Center for Primary Health Care Research, Skåne University Hospital; J. Leffler, PhD, Telethon Kids Institute, University of Western Australia; P.J. Svensson, MD, PhD, Department of Translational Medicine, Lund University; L.A. Trouw, PhD, Department of Rheumatology, Leiden University Medical Center; A.M. Blom, PhD, Department of Translational Medicine, Lund University
| | - Carlo Perricone
- From the Department of Translational Medicine, and Department of Clinical Sciences, Lund University; Center for Primary Health Care Research, Skåne University Hospital, Malmö; Department of Clinical Chemistry and Transfusion Medicine, Halland Hospital, Halmstad, Sweden; Internal Medicine, "Bezhanijska Kosa," University Medical Center, Belgrade, Serbia; Dipartimento di Medicina Interna e Specialità Mediche, Sapienza Università di Roma, Rome, Italy; Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel Aviv, Israel; Telethon Kids Institute, University of Western Australia, Perth, Australia; Department of Rheumatology, Leiden University Medical Center, Leiden, the Netherlands.A. Foltyn Zadura, MSc, Department of Translational Medicine, Lund University; A.A. Memon, PhD, Center for Primary Health Care Research, Skåne University Hospital; L. Stojanovich, MD, PhD, Internal Medicine, "Bezhanijska Kosa," University Medical Center; C. Perricone, MD; F. Conti, MD, PhD; G. Valesini, MD, Dipartimento di Medicina Interna e Specialità Mediche, Sapienza Università di Roma; G. Bogdanovic, MD, PHD, Internal Medicine, "Bezhanijska Kosa," University Medical Center; A. Hillarp, PhD, Department of Clinical Chemistry and Transfusion Medicine, Halland Hospital; Y. Shoenfeld, MD, PhD, Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center; J. Sundquist, MD, PhD, Center for Primary Health Care Research, Skåne University Hospital; J. Leffler, PhD, Telethon Kids Institute, University of Western Australia; P.J. Svensson, MD, PhD, Department of Translational Medicine, Lund University; L.A. Trouw, PhD, Department of Rheumatology, Leiden University Medical Center; A.M. Blom, PhD, Department of Translational Medicine, Lund University
| | - Fabrizio Conti
- From the Department of Translational Medicine, and Department of Clinical Sciences, Lund University; Center for Primary Health Care Research, Skåne University Hospital, Malmö; Department of Clinical Chemistry and Transfusion Medicine, Halland Hospital, Halmstad, Sweden; Internal Medicine, "Bezhanijska Kosa," University Medical Center, Belgrade, Serbia; Dipartimento di Medicina Interna e Specialità Mediche, Sapienza Università di Roma, Rome, Italy; Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel Aviv, Israel; Telethon Kids Institute, University of Western Australia, Perth, Australia; Department of Rheumatology, Leiden University Medical Center, Leiden, the Netherlands.A. Foltyn Zadura, MSc, Department of Translational Medicine, Lund University; A.A. Memon, PhD, Center for Primary Health Care Research, Skåne University Hospital; L. Stojanovich, MD, PhD, Internal Medicine, "Bezhanijska Kosa," University Medical Center; C. Perricone, MD; F. Conti, MD, PhD; G. Valesini, MD, Dipartimento di Medicina Interna e Specialità Mediche, Sapienza Università di Roma; G. Bogdanovic, MD, PHD, Internal Medicine, "Bezhanijska Kosa," University Medical Center; A. Hillarp, PhD, Department of Clinical Chemistry and Transfusion Medicine, Halland Hospital; Y. Shoenfeld, MD, PhD, Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center; J. Sundquist, MD, PhD, Center for Primary Health Care Research, Skåne University Hospital; J. Leffler, PhD, Telethon Kids Institute, University of Western Australia; P.J. Svensson, MD, PhD, Department of Translational Medicine, Lund University; L.A. Trouw, PhD, Department of Rheumatology, Leiden University Medical Center; A.M. Blom, PhD, Department of Translational Medicine, Lund University
| | - Guido Valesini
- From the Department of Translational Medicine, and Department of Clinical Sciences, Lund University; Center for Primary Health Care Research, Skåne University Hospital, Malmö; Department of Clinical Chemistry and Transfusion Medicine, Halland Hospital, Halmstad, Sweden; Internal Medicine, "Bezhanijska Kosa," University Medical Center, Belgrade, Serbia; Dipartimento di Medicina Interna e Specialità Mediche, Sapienza Università di Roma, Rome, Italy; Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel Aviv, Israel; Telethon Kids Institute, University of Western Australia, Perth, Australia; Department of Rheumatology, Leiden University Medical Center, Leiden, the Netherlands.A. Foltyn Zadura, MSc, Department of Translational Medicine, Lund University; A.A. Memon, PhD, Center for Primary Health Care Research, Skåne University Hospital; L. Stojanovich, MD, PhD, Internal Medicine, "Bezhanijska Kosa," University Medical Center; C. Perricone, MD; F. Conti, MD, PhD; G. Valesini, MD, Dipartimento di Medicina Interna e Specialità Mediche, Sapienza Università di Roma; G. Bogdanovic, MD, PHD, Internal Medicine, "Bezhanijska Kosa," University Medical Center; A. Hillarp, PhD, Department of Clinical Chemistry and Transfusion Medicine, Halland Hospital; Y. Shoenfeld, MD, PhD, Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center; J. Sundquist, MD, PhD, Center for Primary Health Care Research, Skåne University Hospital; J. Leffler, PhD, Telethon Kids Institute, University of Western Australia; P.J. Svensson, MD, PhD, Department of Translational Medicine, Lund University; L.A. Trouw, PhD, Department of Rheumatology, Leiden University Medical Center; A.M. Blom, PhD, Department of Translational Medicine, Lund University
| | - Gordana Bogdanovic
- From the Department of Translational Medicine, and Department of Clinical Sciences, Lund University; Center for Primary Health Care Research, Skåne University Hospital, Malmö; Department of Clinical Chemistry and Transfusion Medicine, Halland Hospital, Halmstad, Sweden; Internal Medicine, "Bezhanijska Kosa," University Medical Center, Belgrade, Serbia; Dipartimento di Medicina Interna e Specialità Mediche, Sapienza Università di Roma, Rome, Italy; Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel Aviv, Israel; Telethon Kids Institute, University of Western Australia, Perth, Australia; Department of Rheumatology, Leiden University Medical Center, Leiden, the Netherlands.A. Foltyn Zadura, MSc, Department of Translational Medicine, Lund University; A.A. Memon, PhD, Center for Primary Health Care Research, Skåne University Hospital; L. Stojanovich, MD, PhD, Internal Medicine, "Bezhanijska Kosa," University Medical Center; C. Perricone, MD; F. Conti, MD, PhD; G. Valesini, MD, Dipartimento di Medicina Interna e Specialità Mediche, Sapienza Università di Roma; G. Bogdanovic, MD, PHD, Internal Medicine, "Bezhanijska Kosa," University Medical Center; A. Hillarp, PhD, Department of Clinical Chemistry and Transfusion Medicine, Halland Hospital; Y. Shoenfeld, MD, PhD, Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center; J. Sundquist, MD, PhD, Center for Primary Health Care Research, Skåne University Hospital; J. Leffler, PhD, Telethon Kids Institute, University of Western Australia; P.J. Svensson, MD, PhD, Department of Translational Medicine, Lund University; L.A. Trouw, PhD, Department of Rheumatology, Leiden University Medical Center; A.M. Blom, PhD, Department of Translational Medicine, Lund University
| | - Andreas Hillarp
- From the Department of Translational Medicine, and Department of Clinical Sciences, Lund University; Center for Primary Health Care Research, Skåne University Hospital, Malmö; Department of Clinical Chemistry and Transfusion Medicine, Halland Hospital, Halmstad, Sweden; Internal Medicine, "Bezhanijska Kosa," University Medical Center, Belgrade, Serbia; Dipartimento di Medicina Interna e Specialità Mediche, Sapienza Università di Roma, Rome, Italy; Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel Aviv, Israel; Telethon Kids Institute, University of Western Australia, Perth, Australia; Department of Rheumatology, Leiden University Medical Center, Leiden, the Netherlands.A. Foltyn Zadura, MSc, Department of Translational Medicine, Lund University; A.A. Memon, PhD, Center for Primary Health Care Research, Skåne University Hospital; L. Stojanovich, MD, PhD, Internal Medicine, "Bezhanijska Kosa," University Medical Center; C. Perricone, MD; F. Conti, MD, PhD; G. Valesini, MD, Dipartimento di Medicina Interna e Specialità Mediche, Sapienza Università di Roma; G. Bogdanovic, MD, PHD, Internal Medicine, "Bezhanijska Kosa," University Medical Center; A. Hillarp, PhD, Department of Clinical Chemistry and Transfusion Medicine, Halland Hospital; Y. Shoenfeld, MD, PhD, Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center; J. Sundquist, MD, PhD, Center for Primary Health Care Research, Skåne University Hospital; J. Leffler, PhD, Telethon Kids Institute, University of Western Australia; P.J. Svensson, MD, PhD, Department of Translational Medicine, Lund University; L.A. Trouw, PhD, Department of Rheumatology, Leiden University Medical Center; A.M. Blom, PhD, Department of Translational Medicine, Lund University
| | - Yehuda Shoenfeld
- From the Department of Translational Medicine, and Department of Clinical Sciences, Lund University; Center for Primary Health Care Research, Skåne University Hospital, Malmö; Department of Clinical Chemistry and Transfusion Medicine, Halland Hospital, Halmstad, Sweden; Internal Medicine, "Bezhanijska Kosa," University Medical Center, Belgrade, Serbia; Dipartimento di Medicina Interna e Specialità Mediche, Sapienza Università di Roma, Rome, Italy; Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel Aviv, Israel; Telethon Kids Institute, University of Western Australia, Perth, Australia; Department of Rheumatology, Leiden University Medical Center, Leiden, the Netherlands.A. Foltyn Zadura, MSc, Department of Translational Medicine, Lund University; A.A. Memon, PhD, Center for Primary Health Care Research, Skåne University Hospital; L. Stojanovich, MD, PhD, Internal Medicine, "Bezhanijska Kosa," University Medical Center; C. Perricone, MD; F. Conti, MD, PhD; G. Valesini, MD, Dipartimento di Medicina Interna e Specialità Mediche, Sapienza Università di Roma; G. Bogdanovic, MD, PHD, Internal Medicine, "Bezhanijska Kosa," University Medical Center; A. Hillarp, PhD, Department of Clinical Chemistry and Transfusion Medicine, Halland Hospital; Y. Shoenfeld, MD, PhD, Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center; J. Sundquist, MD, PhD, Center for Primary Health Care Research, Skåne University Hospital; J. Leffler, PhD, Telethon Kids Institute, University of Western Australia; P.J. Svensson, MD, PhD, Department of Translational Medicine, Lund University; L.A. Trouw, PhD, Department of Rheumatology, Leiden University Medical Center; A.M. Blom, PhD, Department of Translational Medicine, Lund University
| | - Jan Sundquist
- From the Department of Translational Medicine, and Department of Clinical Sciences, Lund University; Center for Primary Health Care Research, Skåne University Hospital, Malmö; Department of Clinical Chemistry and Transfusion Medicine, Halland Hospital, Halmstad, Sweden; Internal Medicine, "Bezhanijska Kosa," University Medical Center, Belgrade, Serbia; Dipartimento di Medicina Interna e Specialità Mediche, Sapienza Università di Roma, Rome, Italy; Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel Aviv, Israel; Telethon Kids Institute, University of Western Australia, Perth, Australia; Department of Rheumatology, Leiden University Medical Center, Leiden, the Netherlands.A. Foltyn Zadura, MSc, Department of Translational Medicine, Lund University; A.A. Memon, PhD, Center for Primary Health Care Research, Skåne University Hospital; L. Stojanovich, MD, PhD, Internal Medicine, "Bezhanijska Kosa," University Medical Center; C. Perricone, MD; F. Conti, MD, PhD; G. Valesini, MD, Dipartimento di Medicina Interna e Specialità Mediche, Sapienza Università di Roma; G. Bogdanovic, MD, PHD, Internal Medicine, "Bezhanijska Kosa," University Medical Center; A. Hillarp, PhD, Department of Clinical Chemistry and Transfusion Medicine, Halland Hospital; Y. Shoenfeld, MD, PhD, Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center; J. Sundquist, MD, PhD, Center for Primary Health Care Research, Skåne University Hospital; J. Leffler, PhD, Telethon Kids Institute, University of Western Australia; P.J. Svensson, MD, PhD, Department of Translational Medicine, Lund University; L.A. Trouw, PhD, Department of Rheumatology, Leiden University Medical Center; A.M. Blom, PhD, Department of Translational Medicine, Lund University
| | - Jonatan Leffler
- From the Department of Translational Medicine, and Department of Clinical Sciences, Lund University; Center for Primary Health Care Research, Skåne University Hospital, Malmö; Department of Clinical Chemistry and Transfusion Medicine, Halland Hospital, Halmstad, Sweden; Internal Medicine, "Bezhanijska Kosa," University Medical Center, Belgrade, Serbia; Dipartimento di Medicina Interna e Specialità Mediche, Sapienza Università di Roma, Rome, Italy; Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel Aviv, Israel; Telethon Kids Institute, University of Western Australia, Perth, Australia; Department of Rheumatology, Leiden University Medical Center, Leiden, the Netherlands.A. Foltyn Zadura, MSc, Department of Translational Medicine, Lund University; A.A. Memon, PhD, Center for Primary Health Care Research, Skåne University Hospital; L. Stojanovich, MD, PhD, Internal Medicine, "Bezhanijska Kosa," University Medical Center; C. Perricone, MD; F. Conti, MD, PhD; G. Valesini, MD, Dipartimento di Medicina Interna e Specialità Mediche, Sapienza Università di Roma; G. Bogdanovic, MD, PHD, Internal Medicine, "Bezhanijska Kosa," University Medical Center; A. Hillarp, PhD, Department of Clinical Chemistry and Transfusion Medicine, Halland Hospital; Y. Shoenfeld, MD, PhD, Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center; J. Sundquist, MD, PhD, Center for Primary Health Care Research, Skåne University Hospital; J. Leffler, PhD, Telethon Kids Institute, University of Western Australia; P.J. Svensson, MD, PhD, Department of Translational Medicine, Lund University; L.A. Trouw, PhD, Department of Rheumatology, Leiden University Medical Center; A.M. Blom, PhD, Department of Translational Medicine, Lund University
| | - Peter J Svensson
- From the Department of Translational Medicine, and Department of Clinical Sciences, Lund University; Center for Primary Health Care Research, Skåne University Hospital, Malmö; Department of Clinical Chemistry and Transfusion Medicine, Halland Hospital, Halmstad, Sweden; Internal Medicine, "Bezhanijska Kosa," University Medical Center, Belgrade, Serbia; Dipartimento di Medicina Interna e Specialità Mediche, Sapienza Università di Roma, Rome, Italy; Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel Aviv, Israel; Telethon Kids Institute, University of Western Australia, Perth, Australia; Department of Rheumatology, Leiden University Medical Center, Leiden, the Netherlands.A. Foltyn Zadura, MSc, Department of Translational Medicine, Lund University; A.A. Memon, PhD, Center for Primary Health Care Research, Skåne University Hospital; L. Stojanovich, MD, PhD, Internal Medicine, "Bezhanijska Kosa," University Medical Center; C. Perricone, MD; F. Conti, MD, PhD; G. Valesini, MD, Dipartimento di Medicina Interna e Specialità Mediche, Sapienza Università di Roma; G. Bogdanovic, MD, PHD, Internal Medicine, "Bezhanijska Kosa," University Medical Center; A. Hillarp, PhD, Department of Clinical Chemistry and Transfusion Medicine, Halland Hospital; Y. Shoenfeld, MD, PhD, Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center; J. Sundquist, MD, PhD, Center for Primary Health Care Research, Skåne University Hospital; J. Leffler, PhD, Telethon Kids Institute, University of Western Australia; P.J. Svensson, MD, PhD, Department of Translational Medicine, Lund University; L.A. Trouw, PhD, Department of Rheumatology, Leiden University Medical Center; A.M. Blom, PhD, Department of Translational Medicine, Lund University
| | - Leendert A Trouw
- From the Department of Translational Medicine, and Department of Clinical Sciences, Lund University; Center for Primary Health Care Research, Skåne University Hospital, Malmö; Department of Clinical Chemistry and Transfusion Medicine, Halland Hospital, Halmstad, Sweden; Internal Medicine, "Bezhanijska Kosa," University Medical Center, Belgrade, Serbia; Dipartimento di Medicina Interna e Specialità Mediche, Sapienza Università di Roma, Rome, Italy; Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel Aviv, Israel; Telethon Kids Institute, University of Western Australia, Perth, Australia; Department of Rheumatology, Leiden University Medical Center, Leiden, the Netherlands.A. Foltyn Zadura, MSc, Department of Translational Medicine, Lund University; A.A. Memon, PhD, Center for Primary Health Care Research, Skåne University Hospital; L. Stojanovich, MD, PhD, Internal Medicine, "Bezhanijska Kosa," University Medical Center; C. Perricone, MD; F. Conti, MD, PhD; G. Valesini, MD, Dipartimento di Medicina Interna e Specialità Mediche, Sapienza Università di Roma; G. Bogdanovic, MD, PHD, Internal Medicine, "Bezhanijska Kosa," University Medical Center; A. Hillarp, PhD, Department of Clinical Chemistry and Transfusion Medicine, Halland Hospital; Y. Shoenfeld, MD, PhD, Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center; J. Sundquist, MD, PhD, Center for Primary Health Care Research, Skåne University Hospital; J. Leffler, PhD, Telethon Kids Institute, University of Western Australia; P.J. Svensson, MD, PhD, Department of Translational Medicine, Lund University; L.A. Trouw, PhD, Department of Rheumatology, Leiden University Medical Center; A.M. Blom, PhD, Department of Translational Medicine, Lund University
| | - Anna M Blom
- From the Department of Translational Medicine, and Department of Clinical Sciences, Lund University; Center for Primary Health Care Research, Skåne University Hospital, Malmö; Department of Clinical Chemistry and Transfusion Medicine, Halland Hospital, Halmstad, Sweden; Internal Medicine, "Bezhanijska Kosa," University Medical Center, Belgrade, Serbia; Dipartimento di Medicina Interna e Specialità Mediche, Sapienza Università di Roma, Rome, Italy; Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel Aviv, Israel; Telethon Kids Institute, University of Western Australia, Perth, Australia; Department of Rheumatology, Leiden University Medical Center, Leiden, the Netherlands.A. Foltyn Zadura, MSc, Department of Translational Medicine, Lund University; A.A. Memon, PhD, Center for Primary Health Care Research, Skåne University Hospital; L. Stojanovich, MD, PhD, Internal Medicine, "Bezhanijska Kosa," University Medical Center; C. Perricone, MD; F. Conti, MD, PhD; G. Valesini, MD, Dipartimento di Medicina Interna e Specialità Mediche, Sapienza Università di Roma; G. Bogdanovic, MD, PHD, Internal Medicine, "Bezhanijska Kosa," University Medical Center; A. Hillarp, PhD, Department of Clinical Chemistry and Transfusion Medicine, Halland Hospital; Y. Shoenfeld, MD, PhD, Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center; J. Sundquist, MD, PhD, Center for Primary Health Care Research, Skåne University Hospital; J. Leffler, PhD, Telethon Kids Institute, University of Western Australia; P.J. Svensson, MD, PhD, Department of Translational Medicine, Lund University; L.A. Trouw, PhD, Department of Rheumatology, Leiden University Medical Center; A.M. Blom, PhD, Department of Translational Medicine, Lund University.
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